OMESFormCP076.docx
DOCX document 68 KB Posted
- Attached to
- Sallisaw Plumbing Repair
- Solicitation number
- EV00000875
- Issued by
- Texas County, Oklahoma
About this file
This is a certification form (OMESForm CP076) issued by the Oklahoma state government for use in responding to state solicitations. The form requires responding bidders to submit this certification document along with their bid response to Solicitation #EV00000875. The form serves as a standardized bidder information and compliance documentation tool, requiring bidders to provide general company information including Federal Employer Identification Number or Social Identification Number, Supplier ID, and company name, along with complete contact information for the designated company representative. The form does not specify particular products, services, quantities, response deadlines, site visit requirements, or contract terms, as it functions as a universal certification document applicable across multiple state procurement opportunities.
The form requires bidders to certify compliance with several Oklahoma state requirements and regulations. Bidders must disclose whether they are currently engaged in a boycott of Israeli goods or services, confirm registration status with the Oklahoma Secretary of State (with provisions for exemption documentation if applicable), and provide proof of Workers' Compensation Insurance coverage under the Oklahoma Workers' Compensation Act or submit a signed exemption statement. Additionally, bidders may certify service-disabled veteran business enterprise status if applicable, requiring submission of federal agency verification of service-disabled veteran status, documentation of at least 51% ownership by service-disabled veterans, and proof of management control by service-disabled veterans. The form requires authorized signature, date, printed name, and title of the signing official to validate certification accuracy.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| OMESFormCP021.docx | DOCX document | |
| Bidder_Instructions.docx | DOCX document | |
| Attachment_B_State_General_Terms.pdf | ||
| Exhibit_1.docx | DOCX document | |
| CP004.docx | DOCX document | |
| SolicitationContractAttachmentA.docx | DOCX document |
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Text version
Responding Bidder Information
“Certification for Competitive Bid and Contract” MUST be submitted along with the response to the Solicitation.
1. RE: Solicitation # EV00000875
2. Bidder General Information:
| FEI / SSN : | |
| Supplier ID: |
Company Name:
3. Bidder Contact Information:
Address:
| City: | |
| State: | |
| Zip Code: |
Contact Name:
Contact Title:
| Phone #: | |
| Fax #: |
| Email: | |
| Website: |
4. Bidder currently engaged in a boycott of goods or services from Israel.
YES
NO
5. Registration with the Oklahoma Secretary of State:
YES - Filing Number:
NO - Prior to the contract award, the successful bidder will be required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (www.sos.ok.gov or 405-521-3911).
6. Workers’ Compensation Insurance Coverage:
Bidder is required to provide with the bid a certificate of insurance showing proof of compliance with the Oklahoma Workers’ Compensation Act.
YES – Include with the bid a certificate of insurance.
NO – Exempt from the Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11) – Attach a written, signed, and dated statement on letterhead stating the reason for the exempt status.1
1 For frequently asked questions concerning workers’ compensation insurance, see https://www.ok.gov/wcc/Insurance/index.html
OMES FORM CP 076 Rev. 11/2020
7. Disabled Veteran Business Enterprise Act
YES – I am a service-disabled veteran business as defined in 74 O.S. §85.44E. Include with the bid response 1) certification of service-disabled veteran status as verified by the appropriate federal agency, and 2) verification of not less than 51% ownership by one or more service-disabled veterans, and 3) verification of the control of the management and daily business operations by one or more service- disabled veterans.
NO – Do not meet the criteria as a service-disabled veteran business.
Authorized Signature
Date
Printed Name
Title image1.jpeg
File details come from the government source that posted it. Updated .